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CERTIFICATE OF DEATH
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- NFOR~u?Ht-N~Eft~p~ a IrMwI ~uuuNO ~OONESS STpEET OA R F.p. Np C~Tr OR TONm ST~IE 1iv
: ~iam Koo man +n282 Sout East Walte rrac Po t St. Lucie F1. 3452
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64 o th U. S. . S1 Po . L e Fl . 33452 ~
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Feb. 24 1986 11.30 a.~ ~
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AEGISTIIM ~ ~ DATE RECEIVED 01I IIE(iiSTM11/Yp, D't Yr.)
- r,.,s~.,. c ~y 24, 198b
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ONE TO.OA OUENCE Of. ('~~s) rAtl~ rM b cauM (y - liM und~lyirp ea~M WQ YM~rrai ONOMn onwl ane 6~aM
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OUE TO. 011 AS A CO/tBEOtJENCE Gf~ I Uwrv~t alwsn o+~M ~nA a~an
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1 1.ACG DETEM~aNEOISO~uh/ OATE Oi I!RlUR1I (Yp. D~y. Yr ) NOUR Oi ~W Wiv OESpMSE n07M ~NJURr OCCUMED
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MiJUlIY AT WOAK /Splt~r PUCE Oi WJWIY-M IqnN. I~nn, ~lrNl, IKbry. WACI tOCAT1Oq ST1~ET OR 11 f D NO CITY OII T01NN STATE
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8O5 1 tlar~by 4rtity fhli 10 k~", ~Itru~ arw Correct copy ot ths ~ou, r~~`s~""~~
R~MIr~~ r~aoo~~on f)l~in tfi~ St, lutiE County Health Depa~t• °
P~~ ~0`~'. .8b NOV 19 P 3~29
'$7 FEB -3 P 2~~ ~ 1~'ylid tNti~q rsi~d seal of ?he s~. tuc~~
p~ COI~My~1iM1~1 OpaAm~nt is affix~d.)
FILED : _ . _ .
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v ROGER i . : ~r.
S7. LUC~k GGU~y a Nuu~, ~a. ~o. sY. ~uc~~ ~ti ~ Y: ~i .
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